1. Field of the Invention
The present invention relates to the use of knowledge base systems for the purpose of screening and verifying the results of decision making processes, and more particularly to such systems for decision-making processes in the context of health care.
2. Description Relative to the Prior Art
In the field of health care, as in many other fields involving the accumulation and application of masses of information, the use of artificial intelligence has been looked to as a means of automatic decision making. Artificial intelligence has not yet fulfilled its promise in this regard, however. No such systems provide the reliability required to circumvent the human decision-making process.
However, not withstanding the failures of these systems, artificial intelligence has been used effectively to augment the human decision-making process, rather than replace it. The key to effective use of these systems is constant checking and verification of the computer-generated results by human experts.
Common implementations of such automatic systems include the use of Knowledge bases in computer programs known as "Expert Systems." These systems are known in the art to provide an interactive means of problem solving by accessing information in a user-friendly environment.
In expert systems, information is organized in data trees in which then can be entered by the user at any level. The data is generally arranged hierarchically, so that more detail is derived as the user moves farther toward the tips of tree branches, with more generality toward the root of the tree. In addition to the tree-structured data organization, the knowledge base contains rules for dealing with the data, and for proceeding further down the tree based on the history of the user's current activity.
Such expert systems attempt to emulate human intelligence, and the efficacy of the expert system is dependent on the data contained within the knowledge base, as well as the rules for dealing with this data, and these data and rules must be input prior to use of the system.
To use the expert system, the user begins at a low level, at the "root" of the data tree. At each branch the user makes a decision, and, based on the rules of the knowledge base, the system will give the user a number of specific choices as to how to proceed. The information at the root of the tree is quite general, but as the user continues away from the root the information becomes more and more specific.
Many attempts have been made to utilize such expert systems in the health care setting. In particular, U.S. Pat. No. 5,583,758 describes such a system which provides decisions based on patient data, together with a knowledge base. The results provided by the system are then subjected to review by the health care experts.
Diagnosis systems such as the patent described above suffer from several problems, however. The automated system makes a decision, without providing a continuous rationale for how such decision was made. The decision tree may be thought of as a complex road system, with decisions appearing as branches in the road. Once a wrong branch is taken, for any reason, the decision will probably be wrong.
Furthermore, such systems require frequent updating of the knowledge base. Such updating requires highly-trained medical personnel and computer programmers, and is both time consuming and expensive.
Other approaches to automated assistance in health care decision-making use a statistical data approach. Such systems use statistical calculations to assess the probability that a particular decision will be correct. Examples of statistical systems include Brown et al., MEDICAL STATISTICAL ANALYZING METHOD; PROCESS OF MONITORING PATIENT VITAL SIGNS, U.S. Pat. No. 5,199,439, Altschuler et al., INTERACTIVE STATISTICAL SYSTEM AND METHOD FOR PREDICTING EXPERT DECISIONS, U.S. Pat. No. 5,005,143, and Saito Katsuyoshi et al., DATA PROCESSING SYSTEM WHICH SUGGESTS A PATTERN OF MEDICAL TESTS TO REDUCE THE NUMBER OF TESTS NECESSARY TO CONFIRM OR DENY A DIAGNOSIS, U.S. Pat. No. 4,731,725. Relying on statistical data is an important diagnostic approach, but it is not effective in dealing with cases which fall at the outer ends of the statistical distribution.
The present invention is significantly different from the previous systems in several ways. First, the current system does not attempt to make any diagnosis, but rather acts as a screen or "gate keeper" to alert the decision makers that a proposed intervention or level of care does not meet the pre-determined criteria.
Secondly, the current system is designed so that the user inputting the data to the system need not be the ultimate decision maker. Typically, the original user is a nurse reviewer. Users may include any of the following, however:
a) nurse reviewer; PA1 b) physician assistant; PA1 c) physician; PA1 d) medical director; PA1 e) chief medical officer; and PA1 f) other health care workers who have been trained in the use of the system.
Thirdly, the current system provides constant feedback to show the user how the system makes its decisions, displaying the rules used, and displaying when the criteria are met and when they are not met.
Fourthly, the present system provides additional information in the form of notes and information and appropriate points in the decision process, and further categorizing this information into mandatory notes, which are automatically presented to the user, and informational notes, which may or may not be read at the user's discretion, as well as other categories of notes.
Finally, the present system provides comprehensive user level and management level reports which may be reviewed by the decision maker, typically the doctor in charge of the case, or, alternatively, a group or panel of reviewers or their managers. The reviewer may then re-enact the steps of the decision process, reviewing the exact nature of the decisions made by the system at each point in the decision process.